Hands are the principal carriers of disease-causing germs. It is estimated that if handwashing with soap is widely practiced, approximately 230,000 deaths could be averted.

A single gram of human feces can contain 10 million viruses and one million bacteria.

Handwashing promotion in the community in low-and middle-income countries was found to prevent about 28% of diarrheal episodes by increasing handwashing at key moments. Providing soap in interventions seems to increase the size of the effect.

Prevalence of diseases attributable to no handwashing has steadily declined since the 1990s; between 2000 and 2015, lost DALYs attributed to no handwashing have declined by 19%.

Diarrheal disease is a critical global public health issue. Each year, there are nearly 1.7 billion cases of diarrhea.

Diarrheal disease is the second leading cause of death in children under 5, killing 525,000 each year.22 Diarrhea isresponsible for 9% of all deaths in the under-five age group despite the existence of simple effective treatment.

Handwashing alone can reduce the risk of diarrheal disease by up to 44%.Evidence shows that hygiene is as important as water and sanitation in reducing diarrhea.

Lack of access to sanitation and poor hygiene contribute to approximately 88% of childhood deaths caused by diarrheal diseases.

Study participants who washed hands with soap had 36% fewer fecal bacteria (8%), while those rinsing with only water showed 21% fewer than those who did not wash hands at all.

Handwashing with soap can reduce the risk of respiratory infections, such as pneumonia, by 16%.

Pneumonia is the leading cause of death for children under the age of 5 resulting in 921,000 childhood deaths in 2015, or 16% of all deaths in the age group, most of them affecting those under the age of 2.

Pneumonia and diarrhea remain major killers of young children. Together, these diseases account for 29% of all deaths of children under 5 years of age and result in the loss of 2 million young lives each year.

72% of deaths associated with diarrhea and 81% associated with pneumonia happen in the first 2 years of life, suggesting that an increased emphasis on prevention and treatment in neonates and children younger than 2 years is crucial.

Nearly three-quarters of mortality associated with diarrhea and pneumonia is concentrated in 15 high-burden countries

Handwashing education in the community reduces the number of people who become ill with diarrhea by 31%, reduces diarrheal illness among people with weakened immune systems by 58%, and reduces respiratory infections by up to 21%.

A recent study indicated that in some developing countries, annual net costs of diarrhea and pneumonia incur more than $12 billion per year, while estimated costs of a national handwashing program would be less than $100 million and bring $2-5 billion in savings.

Evidence suggests that access to soap and water can help improve child growth. It is estimated that handwashing with soap and clean drinking water could reduce the loss of nutrients through diarrhea and reduce stunting in children under 5 by up to 15%.

Good handwashing can help reduce undernutrition, which contributes to 73% of the diarrheal deaths each year.

The number of times a child’s hands were washed per day and the use of soap were two of seven independent predictors of stunting in children under 5. Each additional handwashing episode per day decreased the likelihood of child stunting by 24%. Never or rarely using soap during a child’s handwashing was associated with a 3.6-times higher risk of stunting.

Unlike household access to drinking-water and sanitation, no global mechanism exists to monitor handwashing practices in homes and communities. Furthermore, it is difficult to obtain reliable global estimates on handwashing with soap. However, in a recent systematic review of 42 studies of observed handwashing with soap in 19 countries, it was estimated that only 19% of people worldwide wash their hands after potential contact with excreta (Freeman et al., 2014). Despite indications of their importance for health and nutrition, few rigorous data exist on food and environmental hygiene practices.

Hands are the principal carriers of disease-causing germs. It is estimated that if handwashing with soap is widely practiced, approximately 230,000 deaths could be averted.

A single gram of human feces can contain 10 million viruses and one million bacteria.

Diarrheal disease is a critical global public health issue. Each year, there are nearly 1.7 billion cases of diarrhea.

Handwashing alone can reduce the risk of diarrheal disease by up to 44 percent.

Evidence shows that hygiene is as important as water and sanitation in reducing diarrhea.

Lack of access to sanitation and poor hygiene contributes to approximately 88% of childhood deaths caused by diarrheal diseases.

Handwashing with soap is easy, efficacious, and the most cost-effective WASH intervention for reducing diarrhea, but it is often overlooked.

Diarrhea is responsible for children missing 272 million school days each year. A recent study suggests that handwashing with soap at critical times could help reduce school absenteeism 40-50 percent. In an intervention in Kenya, children in schools that received a comprehensive school-based WASH intervention, including hygiene promotion, had nearly a 50 percent reduction in diarrheal illness.

One study found that in patients with AIDS, handwashing with soap reduced the episodes of diarrheal illnesses.

Pneumonia is the leading causes of death for children under the age of 5 resulting in 1.1 million childhood deaths in 2012—17 percent of all deaths in the age group. Every day in 2012, pneumonia killed more than 3,000 children under the age of five.

Handwashing with soap can reduce pneumonia infections by approximately 25 percent.

Evidence suggests that access to soap and water can help improve child growth. It is estimated that handwashing with soap and clean drinking water could reduce the loss of nutrients through diarrhea, and reduce stunting in children under the age of five by up to 15 percent.

Three million neonatal deaths occur each year, and neonatal infections account for approximately 36 percent of these deaths. Evidence suggests that handwashing with soap can significantly reduce newborn deaths. For example, in one study, the mortality rate among neonates exposed to birth attendants and mothers who had good handwashing practices was approximately 40% less than neonates whose birth attendants and mothers had poor handwashing practices.

70 countries had comparable data available on handwashing with soap and water, representing 30 per cent of the global population.

Coverage of basic handwashing facilities with soap and water varied from 15 per cent in sub-Saharan Africa to 76 per cent in Western Asia and Northern Africa, but data are currently insufficient to produce a global estimate, or estimates for other SDG regions.

In Least Developed Countries, 27 per cent of the population had basic handwashing facilities with soap and water, while 26 per cent had handwashing facilities lacking soap or water. The remaining 47 per cent had no facility.

In sub-Saharan Africa, three out of five people with basic handwashing facilities (89 million people) lived in urban areas.

Many high-income countries lacked sufficient data to estimate the population with basic handwashing facilities.

80% of all infectious diseases are transmitted by touch. According to experts, without a vaccine, the single most important thing you can do to prevent getting the flu is to wash your hands.

The Solution to Pollution is Dilution. While soap may not kill all viruses, thorough hand washing will decrease the viral counts to a point below the infectious threshold.

Caught in the act (or lack of). 95% of the population says that they wash their hands after using a public toilet. However when 8,000 people were monitored across five large cities in the US, they found the actual number to be more like 67%.

Do as I say, not as I do…A poll of pediatric ICU physicians showed that they claimed their rate of hand washing between patients was 73%, but when followed and observed, the hand washing rate was found to be less than 10%. Listen carefully and you can hear Dr. Semmelweis rolling over in his grave. The top excuses for not hand washing among doctors? Too busy and dry skin.

Where’s the dirt?CDC studies show that the number of bacteria per square centimeter on the human body are as follows: Scalp – 1,000,000 Forearm – 10,000 Arm pit – 500,000 Abdomen – 40,000 Hands of medical personnel – 40,000 to 500,000 When it comes to hands, fingernails and the surrounding areas harbor the most microorganisms.

Who has it? A recent study showed that 21% of the health care workers in ICU had varying counts of Staphylococcus aureus on their hands.

Too busy? One study demonstrated that hand washing guidelines were followed 25% of the time during times when the floor was overcrowded and understaffed. Compliance rose to 70% when the floor was properly staffed and not overcrowded with patients.

And the winner is… Many studies have shown that alcohol rubs are more effective than plain or even antimicrobial soaps, unless the hands are heavily soiled. However we can’t get overconfident with alcohol rubs. Despite its effectiveness against many organisms, alcohols have very poor activity against bacterial spores, protozoan oocysts, and certain non-enveloped (nonlipophilic) viruses. In addition, alcohol has no residual effect as some antimicrobial soaps do.

How long is enough? The CDC recommends at least 15 seconds. However, studies show that the reduction of skin bacteria is nearly ten times greater by washing with soap for 30 seconds rather than 15. Even so, remember that alcohol gels are even more effective than soap. The average wash time for health care workers? 9 seconds. Children (and why not adults?) are taught to sing “Yankee Doodle Dandy” start to finish before rinsing. This takes about 15 seconds. If you don’t know the words to Yankee Doodle, the Happy Birthday song sung twice will suffice.

Some like it hot.But if they do, hot water can increase the chance of dermatitis. Hot or warm water has not been proven to increase the effectiveness of hand washing. Cold water, though not as comfortable, produces less skin damage from detergents especially with repeated washings.

The two layers of bacteria. The outer layer of bacteria found on your hands is termed “Transient Flora”. This layer is potentially the most dangerous for transmitting disease from one person to another. Fortunately, it is also the most easily eliminated by hand washing. The deeper layer is called “Resident Flora”. This bacterial population is more likely to be made up of innocuous bacteria such as Staphylococcus epidermidis and Corynebacteria spp. (diptheroids); and is more resistant to washing, since they occupy the deeper layers of skin cells.

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